Please register to participate in our discussions with 2 million other members - it's free and quick! Some forums can only be seen by registered members. After you create your account, you'll be able to customize options and access all our 15,000 new posts/day with fewer ads.
“Have no third party coverage for Vaccines OR be enrolled in a Medicare Part D Prescription Drug Plan and have spent at least $600 on prescription medicines through your Medicare Part D Prescription Drug Plan during this calendar year”.
I called Medicare and they don’t cover the shot, part D covers it, but it costs over $300.00, it was free with Obamacare.
So far I have checked two Wellcare formularies for 2020 and they both say that Shingrix is covered at the tier 3 level, which is $47.
I get all the lab tests done twice a year. I asked my dr. last time I was there why I was coming twice a year and why I was getting lab tests that often and she said it was because I am on cholesterol medicine and a couple other ones. Apparently that changes the rules of why the labs are covered. I was also told the wellness visit is only a BP and temp and O2 check and the doctor goes over lab results. If the patient starts talking about anything more and there is more of a physical exam performed it won't be covered by medicare and becomes a regular medical physical which may or may not be covered at that frequency.
I am lucky I used to have a dr. who would talk and discuss things with me regardless of which visit I was there for..and order a pres. if I needed something different... but she's moved away and I am now starting over.
Our medicare (regular + a supplement policy) has been a way better experience than we had under private insurance. If you had a really really good policy paid for by a big company, your experience might be different, but basically we've had to pay just about nothing except for a test or two which was ordered before the year was out (one psa test and they almost did a mamogram before the year was out which wasn't covered either). I would hate to go back to the old insurance we had.
I qualified for Medicare in August and set up a "Welcome to Medicare" visit. The nurse practitioner that I chose (there is a shortage of PCP's that take Medicare here in the Prescott, AZ area) reviewed my records, took my vitals, listened to my lungs and heart - and told me that she heard a heart murmur (absolutely NO history, and I had a complete physical by my PCP in CO in April) so she sent me for an echocardiogram... which showed nothing. So far I have only been billed for $72; I have Medicare with Plan G AARP supplement. I keep thinking there'll be another bill; who knows??
What I'm more confused about is when to schedule my next visit. I will need a med refill in April; I'll also need a dexascan (hx of osteoporosis and it's due) and mammogram. But do I have to wait a year from my "Welcome to Medicare" visit to have a wellness visit?? I guess I'll message my NP and ask her to extend my prescription (synthroid, and technically will need blood work for THAT; sheesh) 'til August.
I worked for a hospital in Colorado. My insurance coverage, particularly for preventative stuff, was awesome. I am so not thrilled with the confusion of Medicare.
Does anyone know whether the cholesterol test that is paid for under the "paid for once every 5 years" group (described as "tests for cholesterol, lipid, and triglyceride levels") is the less-expensive/less detailed test, or the better/gold-standard VAP test that shows the LDL Pattern (A, B, or A/B) that you have? The other test does not do that.
Because the less expensive test is, IMHO, useless. Okay, well, it's better than no test at all but it doesn't give the same level of information as the VAP test does.
I am assuming that "once every 5 years" is counted only from the point at which one has first enrolled in Medicare Part B? Not that it really matters in my case because the last time I had the VAP test was 2008, lol
What I'm more confused about is when to schedule my next visit. I will need a med refill in April; I'll also need a dexascan (hx of osteoporosis and it's due) and mammogram.
But do I have to wait a year from my "Welcome to Medicare" visit to have a wellness visit?? I guess I'll message my NP and ask her to extend my prescription (synthroid, and technically will need blood work for THAT; sheesh) 'til August.
You must wait another year before scheduling Wellness:
Quote:
If you've had a “Welcome to Medicare” visit within the last 12 months, you must wait 12 months after your Welcome visit to schedule your Annual Wellness Visit.
Schedule visit(s) for followup care outside of Wellness. Provider should bill it as a normal office visit to which Medicare will assign a reimbursement. After your deductible of $198, Medicare and supplement should pay all of it. If you need several visits because of various issues, Medicare should cover it. Welcome and Wellness are too tricky to navigate for followup care, imo.
Fwiw, I recently had lab work done at an urgent care center. Medicare insurer was billed $446. Per Medicare's reimbursement schedule using 2017 codes - lab will get about $58 - not $446. The actual visit and procedure - totaling one hour - performed by the NP was billed at $846, provider will get $202. In total, provider will be paid about 20% of the $1,292 billed.
Last edited by Ariadne22; 01-17-2020 at 07:44 PM..
Does anyone know whether the cholesterol test that is paid for under the "paid for once every 5 years" group (described as "tests for cholesterol, lipid, and triglyceride levels") is the less-expensive/less detailed test, or the better/gold-standard VAP test that shows the LDL Pattern (A, B, or A/B) that you have? The other test does not do that.
Because the less expensive test is, IMHO, useless. Okay, well, it's better than no test at all but it doesn't give the same level of information as the VAP test does.
If you know the code for that procedure, see if it is listed on Medicare's schedule, here:
I found a link that gives two CPT codes for the VAP test: 83701 and 84478. 83701 is listed with a price of $34.05 next to it. 84478 is also listed but with a notation of QW and also $7.88 in the price column.
Does it matter that your linked PDF says "Kentucky Only" and "Kentucky and Ohio Part B" ? I am not in either of those states.
Please register to post and access all features of our very popular forum. It is free and quick. Over $68,000 in prizes has already been given out to active posters on our forum. Additional giveaways are planned.
Detailed information about all U.S. cities, counties, and zip codes on our site: City-data.com.